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<!DOCTYPE html>
<html>
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <title></title>
        <link rel="stylesheet" type="text/css" href="../style/styles.css"/> 

    </head>
    <body>
           <div id="whole">
            <br/>
          <?php include 'header.php'; ?>
          
          <?php include 'menu.php'; ?>
            
           <div id="content">
               
           <div id="form" style="margin: 300px 0 0 0;">		

              

               <!--			  <form>
			  <fieldset>
             <legend style="color: green; font-weight: 100;">Document Information</legend>
        
      <div class="sad" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
  
          <div><label for="a">Document:</label><input id="a" name="x"></div>
          <div><label for="b">Document Date:*</label><input id="b" name="fname"></div>
          <div><label for="c">Document Number:*</label><input id="c" name="streetadd"></div>
          <div><label for="d">Document Image:</label><input id="c" name="streetadd"></div>
          <div><label for="a">Document Ref </label><input id="c" name="x"></div>
          <div><label for="b">Document Ref No. </label><input id="c" name="x"></div>
          <div><label for="c">Document Ref Date</label><input id="c" name="x"></div>
          <div><label for="c">Borrower Code:</label><input id="c" name="x"></div>
          <div><label for="c">Borrower Name:</label><input id="c" name="x"></div>
        
          
      </div>
        
             </fieldset> 
         </form>-->
             
               	
               <form>
			  <fieldset>
             <legend style="color: green; font-weight: 100;">Loan Information</legend>
        
      <div class="loaninfo" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
  
          <label for="a">Loan Classification*</label>
              <select>
                  <option></option>
                  <option>New</option>
                  <option>Renew</option>
              </select>
          
          <label for="loantype" style="margin-left: 86px;">Loan Type*</label>
              <select>
                  <option></option>
                  <option>100</option>
                  <option>60</option>
                  <option>30</option>
              </select><br/>
          
          <label for="loanterm">Loan Term*</label><input type="text" name="loanterm"/>
          <label for="amountapplied">Amount Applied*</label><input type="text" name="amountapplied"/>
          <label for="amountrequested">Amount Requested*</label><input type="text" name="amountrequested"/>
        
      </div>
        
             </fieldset> 
         </form>
               

	
   <div class="borrowerinfo" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
         
    <fieldset>
        
             <legend style="color: green; font-weight: 100;">Borrower Information</legend>
        
        <b>Borrower Information</b><br/>
          
          <label for="fname">First Name*</label><input type="text" name="fname"/>
          <label for="mname">Middle Name*</label><input type="text" name="mname"/>
          <label for="lname">Last Name*</label><input type="text" name="lname"/><br/>
          <label for="acode">Area Code</label>
           <select>
                  <option></option>
                  <option>SNC01</option>
                  <option>SNC02</option>
                  <option>SNC03</option>
           </select><br/><br/> 
<hr/>
          <b>Current Home Address</b><br/>
          
          <label for="streetadd">Street Address*</label><input type="text" name="streetadd"/>
          <label for="barangay">Barangay*</label><input type="text" name="barangay"/>
          <label for="municity">Municipality/City*</label><input type="text" name="municity"/><br/>
          <label for="postcode">Postal Code*</label><input type="text" name="postcode"/>
          <label for="province">Province*</label><input type="text" name="province"/>
          <label for="presaddstab">Present Address Stability*</label>
          <select>
              <option></option>
              <option>Renting</option>
              <option>Owned/Mortgage</option>
              <option>Owned/Clean Title</option>
              <option>Free</option>
          </select>
          
          <label for="yearstay">Years of Stay*</label>
          <select>
              <option></option>
              <option>0</option>
              <option>1</option>
              <option>2</option>
              <option>3</option>
              <option>4</option>
              <option>5</option>
              <option>6</option>
              <option>7</option>
              <option>8</option>
              <option>9</option>
              <option>10</option>
          </select>
        
          <label for="yearstay" style="margin-left: 114px;">Months of Stay*</label>
          <select>
              <option></option>
              <option>0</option>
              <option>1</option>
              <option>2</option>
              <option>3</option>
              <option>4</option>
              <option>5</option>
              <option>6</option>
              <option>7</option>
              <option>8</option>
              <option>9</option>
              <option>10</option>
              <option>11</option>
              <option>12</option>
          </select><br/><br/>
          <hr/>
          <b>Provincial Home Address</b>&<br/>
          
  <label for="prostreetadd">Street Address*</label><input type="text" name="prostreetadd"/>
          <label for="probarangay">Barangay*</label><input type="text" name="probarangay"/>
          <label for="promunicity">Municipality/City*</label><input type="text" name="promunicity"/><br/>
          <label for="propostcode">Postal Code*</label><input type="text" name="propostcode"/>
          <label for="proprovince">Province*</label><input type="text" name="proprovince"/>
          <label for="propresaddstab">Present Address Stability*</label>
          <select>
              <option></option>
              <option>Renting</option>
              <option>Owned/Mortgage</option>
              <option>Owned/Clean Title</option>
              <option>Free</option>
          </select>
          
          <label for="proyearstay">Years of Stay*</label>
          <select>
              <option></option>
              <option>0</option>
              <option>1</option>
              <option>2</option>
              <option>3</option>
              <option>4</option>
              <option>5</option>
              <option>6</option>
              <option>7</option>
              <option>8</option>
              <option>9</option>
              <option>10</option>
          </select>
        
          <label for="proyearstay" style="margin-left: 114px;">Months of Stay*</label>
          <select>
              <option></option>
              <option>0</option>
              <option>1</option>
              <option>2</option>
              <option>3</option>
              <option>4</option>
              <option>5</option>
              <option>6</option>
              <option>7</option>
              <option>8</option>
              <option>9</option>
              <option>10</option>
              <option>11</option>
              <option>12</option>
          </select><br/>
          <hr/>
            
          <b>Personal Information</b><br/>
          
  <label for="prostreetadd">Date of Birth*</label><input type="text" name="prostreetadd"/>
          <label for="probarangay">Age*</label><input type="text" name="probarangay"/>
          <label for="promunicity">Place of Birth*</label><input type="text" name="promunicity"/><br/>
          <label for="propostcode">Religion*</label><input type="text" name="propostcode"/>
          <label for="proprovince">Citizenship*</label><input type="text" name="proprovince"/>
     <label for="proprovince">Civil Status*</label>
     <select>
         <option></option>
         <option>Single</option>
         <option>Married</option>
         <option>Separated</option>
         <option>Annulled</option>
         <option>Widowed</option>
         
     </select><br/>
     <label for="proprovince">Contact No.</label><input type="text" name="proprovince"/>
     
</fieldset> 
    
    
       
</div>

<div class="spousendependent" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
         
    <fieldset>
        
             <legend style="color: green; font-weight: 100;">Spouse and Dependents</legend>
        
        <b>Spouse Name</b><br/>
          
          <label for="fname">First Name*</label><input type="text" name="fname"/>
          <label for="mname">Middle Name*</label><input type="text" name="mname"/>
          <label for="mname">Middle Name*</label><input type="text" name="mname"/>
    <hr/>
    
     <b>Spouse Provincial Home Address</b><br/>
          
          <label for="streetadd">Street Address</label><input type="text" name="streetadd"/>
          <label for="barangay">Barangay</label><input type="text" name="barangay"/>
          <label for="municity">Municipality/City</label><input type="text" name="municity"/>
    
          <label for="postalcode">Postal Code</label><input type="text" name="postalcode"/>
          <label for="prov">Province</label><input type="text" name="prov"/><hr/><br/>
    
          
          <b>Spouse Personal Information</b><br/>
          
          <label for="streetadd">Date of Birth</label><input type="text" name="streetadd"/>
          <label for="spousepob">Place of Birth</label><input type="text" name="spousepob"/>
          <label for="spouserelig">Religion</label><input type="text" name="spouserelig"/><br/>
    
          <label for="spouseciti">Citizenship</label><input type="text" name="spouseciti"/><hr/><br/>
   
          <b>Children/Dependents</b><br/>
          
          <label for="chilname">Name</label><input type="text" name="chilname"/>
          <label for="spousepob">Relationship</label><input type="text" name="spousepob"/>
          <label for="spouserelig">Age</label><input type="text" name="spouserelig"/><br/>
          <input type="submit" value="Add More" name="submit"/>
    </fieldset>
</div>

<div class="businessinfo" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
         
    <fieldset>
        
             <legend style="color: green; font-weight: 100;">Business Information</legend>
        
        <b>Business Name and Type</b><br/>
        <h6 style="color: red;">Note: At least one (1) business is required.</h6>
          <label for="fname">Business Type</label><input type="text" name="fname"/>
          <label for="mname">Business Name</label><input type="text" name="mname"/><br/>
          <input type="submit" value="Add More" name="submit"/>
          <hr/><br/>
          
          
        <b>Business Address</b><br/>
          <label for="fname">Street Address</label><input type="text" name="fname"/>
          <label for="mname">Barangay</label><input type="text" name="mname"/>
          <label for="mname">Municipality/City</label><input type="text" name="mname"/>
          <label for="mname">Postal Code</label><input type="text" name="mname"/>
          <label for="mname">Province</label><input type="text" name="mname"/><br/>
          
          <label for="mname">Business Stability</label><input type="text" name="mname"/>
          <label for="mname">Years in Business</label>
          <select>
              <option>0</option>
              <option>1</option>
              <option>2</option>
              <option>3</option>
              <option>4</option>
              <option>5</option>
              <option>6</option>
              <option>7</option>
              <option>8</option>
              <option>9</option>
              <option>10</option>
          </select>
          <label for="monthsbusiness" style="margin-left: 115px;">Months in Business</label>
                   <select>
              <option>0</option>
              <option>1</option>
              <option>2</option>
              <option>3</option>
              <option>4</option>
              <option>5</option>
              <option>6</option>
              <option>7</option>
              <option>8</option>
              <option>9</option>
              <option>10</option>
              <option>11</option>
              <option>12</option>
          </select><br/>
          
          <input type="submit" value="Add More" name="submit"/><br/><br/>
         <hr/>
        <b>Statement of Monthly Income</b><br/>
          <label for="statebusiness">Business</label><input type="text" name="statebusiness"/><br/>
          <label for="stateemploy">Employment</label><input type="text" name="statemploy"/><br/>
          <label for="statespouse">Spouse Income</label><input type="text" name="statespouse"/><br/>
          <label for="stateother">Other Resources</label><input type="text" name="stateother"/><br/>
          <label for="stategross">Gross Income</label><input type="text" name="stategross"/><br/><br/>
          <b>Less Expense</b><br/>
          <label for="stateremt">Rent</label><input type="text" name="staterent"/><br/>
          <label for="stateemploy">Food and Clothing</label><input type="text" name="stateemploy"/><br/>
          <label for="stateemploy">Education</label><input type="text" name="stateemploy"/><br/>
          <label for="stateout">Outstanding Loan</label><input type="text" name="stateout"/><br/>
          <label for="statetotal">Total Expense</label><input type="text" name="statetotal"/><br/>
          <label for="stateincome">Net Income Before Tax</label><input type="text" name="stateincome"/><br/><br/>
          <hr/>
          
        <b>Loans with Banks and Other Institutions</b><br/>
          <label for="statebusiness">Name</label><input type="text" name="statebusiness"/>
          <label for="stateemploy">Principal Amount</label><input type="text" name="statemploy"/> 
          <label for="statespouse">Balance</label><input type="text" name="statespouse"/><br/>
          <input type="submit" value="Add More"/>

    
          
    </fieldset>
</div>



<div class="Coborrower and Character References" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
    <fieldset>
        <legend style="color: green; font-weight: 100;">Coborrower and Character References</legend>
        <b>Co-borrower Name</b><br/>
          <label for="statebusiness">First Name</label><input type="text" name="statebusiness"/>
          <label for="stateemploy">Middle Name</label><input type="text" name="statemploy"/> 
          <label for="statespouse">Last Name</label><input type="text" name="statespouse"/>
          <label for="statespouse">Religion</label><input type="text" name="statespouse"/>
          <hr/><br/>
        
          <b>Co-borrower Address</b><br/>
          <label for="statebusiness">Street No.</label><input type="text" name="statebusiness"/>
          <label for="stateemploy">Barangay</label><input type="text" name="statemploy"/> 
          <label for="statespouse">Municipality/City</label><input type="text" name="statespouse"/>
          <label for="statespouse">Province</label><input type="text" name="statespouse"/>
          <label for="statespouse">Postal Code</label><input type="text" name="statespouse"/>
          <hr/><br/>
      
          
          <b>Character and Credit References</b><br/>
          <h6 style="color: red;">Note: At least one (1) business is required.</h6>
          
          <label for="statebusiness">Name</label><input type="text" name="statebusiness"/>
          <label for="stateemploy">Address</label><input type="text" name="statemploy"/> 
          <label for="statespouse">Position/Occupation</label><input type="text" name="statespouse"/><br/>
          <input type="submit" value="Add More"/>
          <hr/><br/>
      
          
    </fieldset>
</div>

<div class="Coborrower and Character References" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
    <fieldset>
        <legend style="color: green; font-weight: 100;">Requirements</legend>
        <b>At least 2 requirements are required.</b><br/>
          <input type="checkbox" name="statespouse"/>Business Permit<br/>
          <input type="checkbox" name="statespouse"/>Barangay Clearance<br/>
          <input type="checkbox" name="statespouse"/>2 x 2 ID Picture<br/>
          <input type="checkbox" name="statespouse"/>Residence Certificate<br/>
          <input type="checkbox" name="statespouse"/>Picture of Collaterals<br/>
          <input type="checkbox" name="statespouse"/>Picture of Business Establishment<br/>
          <input type="checkbox" name="statespouse"/>Photocopy of Business Permit(barangay/mayor)<br/>
          <input type="checkbox" name="statespouse"/>Photocopy of Permit to Operate (PUJ & TODA)<br/>
          <input type="checkbox" name="statespouse"/>1 copy of 2x2 ID Picture<br/>
          <input type="checkbox" name="statespouse"/>Photocopy of 1 valid ID (borrower)<br/>
          <input type="checkbox" name="statespouse"/>Photocopy of 1 valid ID (co-borrower)<br/>
          <input type="checkbox" name="statespouse"/>Picture of collateral<br/>
          <input type="checkbox" name="statespouse"/>Picture of business establishment with the bo<br/>
          <input type="checkbox" name="statespouse"/>Original proof of billing<br/>
          <input type="checkbox" name="statespouse"/>Authorization of spouse with photocopy of ID<br/>
          <input type="checkbox" name="statespouse"/>Authorization of parents/certification from t<br/>
          <input type="checkbox" name="statespouse"/>Original OR/ CR and stencil (chassis no. & engine no.) "require duplicate key for office safekeeping<br/>
    </fieldset>
</div>

</div>
               
               
   </div>

          
          <?php include 'footer.php'; ?>
            
        </div>

    </body>
</html>
